From the Guidelines
Hyperbaric oxygen therapy (HBOT) is not recommended as a standard treatment for post-concussion syndrome due to the lack of robust evidence supporting its effectiveness. The current guidelines emphasize the need for more methodologically sound research evaluating nonpharmacological treatments for persistent symptoms after concussion or mild traumatic brain injury (mTBI) 1. While HBOT may be considered as a complementary approach, its use should be cautiously weighed against the potential benefits and limitations.
Key Considerations
- The most recent and highest quality study available, a systematic review and meta-analysis published in 2021 in JAMA Network Open, highlights the urgent need for more robust research on nonpharmacological treatments for persistent postconcussion symptoms 1.
- Active management and treatment of post-concussion syndrome (PCS) through individual disciplines targeting specific problems and through interdisciplinary rehabilitation are recommended based on the best available evidence to date 1.
- HBOT involves breathing 100% oxygen in a pressurized chamber, which can increase oxygen delivery to brain tissues, potentially reducing inflammation and promoting neurogenesis.
- However, side effects such as ear pressure, temporary myopia, and claustrophobia can occur, and insurance coverage is often limited due to its off-label use for PCS.
Clinical Approach
- Patients with post-concussion syndrome should first undergo standard management including rest, gradual return to activities, and treatment of specific symptoms.
- Consultation with both a neurologist and a hyperbaric medicine specialist is crucial to determine if HBOT is appropriate for a patient's specific situation, considering the lack of strong evidence supporting its use for PCS.
- Given the current state of evidence, interdisciplinary rehabilitation and active management of specific symptoms are the recommended approaches for treating post-concussion syndrome, with HBOT considered only as a potential complementary therapy in select cases, pending further research 1.
From the Research
Hyperbaric Oxygen Therapy for Post-Concussion Syndrome
- Hyperbaric oxygen therapy (HBOT) has been studied as a potential treatment for post-concussion syndrome (PCS) with varying results 2, 3, 4, 5, 6.
- A systematic review and dosage analysis of HBOT in mild traumatic brain injury persistent postconcussion syndrome found that HBOT at 1.5 atmospheres absolute (ATA) demonstrated statistically significant symptomatic and cognitive improvements 2.
- A randomized controlled trial found that 40 HBOT sessions at 150 kPa improved symptoms and cognitive function in subjects with persistent postconcussion syndrome compared to a control group 4.
- However, another study found no evidence of efficacy for HBOT in treating PCS at 2.0 ATA or 1.5 ATA 5.
- A randomized prospective trial found that HBOT can improve post-concussion syndrome years after mild traumatic brain injury, with significant improvements in cognitive function and quality of life 6.
Key Findings
- HBOT at 1.5 ATA appears to be the most effective dose for improving symptoms and cognitive function in PCS patients 2, 4.
- Increased pressure within a narrow range may be more important than increased oxygen for achieving improvements in PCS symptoms 2.
- Comorbid post-traumatic stress disorder (PTSD) may enhance the effectiveness of HBOT in improving PCS symptoms 2.
- HBOT may induce neuroplasticity leading to repair of chronically impaired brain functions and improved quality of life in mTBI patients with prolonged PCS 6.